Predictors of infection, symptoms development, and mortality in people with SARS-CoV-2 living in retirement nursing homes

Abstract

Introduction: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death.

Methods and findings: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk.

Conclusions: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.

Fig 1. Forrest Plots of multivariate logistic regression estimates of factors associated with SARS-CoV-2 infection.

Multivariable model includes all variables selected by a backward selection that were retained with a p-value less than 0.2 level. OR: Odds Ratio; CI: Confidence Interval; COPD: chronic obstructive pulmonary disease; CHD: cardiovascular disease; ARBs: Angiotensin II receptor blockers.

Fig 2. Distribution of 264 patients with SARS-CoV-2 infection according to age groups and mortality rates.

Fig 3. Forrest Plots of multivariate Cox proportional hazards model regression estimates of factors associated with mortality.

Multivariable model includes all variables selected by a backward selection that were retained with a p-value less than 0.2 level. HR: Hazard Ratio; CI: Confidence Interval; COPD: chronic obstructive pulmonary disease; LMWH: low molecular weight heparin.